Form Abl-29 - Application For Business/club Local Option Permit
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1STATE OF SOUTH CAROLINA
ABL-29
DEPARTMENT OF REVENUE
(Rev. 4/25/01)
APPLICATION FOR BUSINESS/CLUB
4250
LOCAL OPTION PERMIT
Mail to: SC Department of Revenue, ABL Section, Columbia, SC 29214-0910.
For Office Use Only
4
DLN
4
File Number
4
Period Covered
Important information: You may apply for this permit by mail or in person to the address listed above. For your
convenience, you may also apply for this permit in person only at one of the service windows at a Department of
Revenue district office. District offices are located in: Charleston: 3 Southpark Circle, Suite 202; Florence: 1452 West
Evans St.; Greenville: 211 Century Drive, Suite 210-B. No mail applications will be accepted at the district offices of
Charleston, Florence or Greenville.
PLEASE TYPE OR PRINT:
1. Name
Title
2. Type of business/club (
) Hotel/Motel
(
) Restaurant
( ) Private Club
3. Business/club name
4. Business address (must be the same as on permanent minibottle license).
Street number/name, box number, rural route
City
County
Zip Code
5. Social security number
Federal ID number
6. Retail License number
Telephone number
Date(s) permit being applied for:
MONTH/YEAR
SUNDAY DATE
FEES DUE
$
$
$
$
$
$
4
Total fees due for all dates
$
LOP 14-3970
Under penalty of perjury and revocation of all licenses/permits held in my name, I certify by my signature below that a
permanent minibottle license has been issued in my name at the address shown in item four above. I understand if a
violation of any alcoholic beverage laws or regulations occurs during the period covered by the local option permit, that I
and/or the organization may be charged and if found guilty, that all permanent licenses/permits and unexpired local
option permits may be suspended or revoked and all permit fees forfeited. I further certify that the business/club located
at the address shown in item four above is in the city/county limits of
and that a local referendum
has been passed authorizing the issuance of the local option permit applied for.
Applicant, individually and on behalf of the organization
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